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• SAN JOAQUIN COUNTY • ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Jiffy Lube #2497 Page 2of 3 Facility Address: City: Inspection Date: 4715 N West Lane Stockton Jun 6, 2013 FA#: PR#: Program Element: FA0010067 �53'J 2831 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_1,320 gallons in tanks" and containers". Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) ❑X Containers (2821) #of Containers: 2 TA#: TA0518008 1 Total Capacity: gallons llons Product Type:water + oil (mop water) (per tank or cumulative for containers by product type) Install Date: ❑X Tank(2820) E] Containers (2821) #of Containers: TA#: TA0516471 2 120 Product Type: motor oil (5W-20) Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank(2820) E] Containers (2821) #of Containers: TA#: TA0516472 3 85 Product Type: motor oil (5W-30) Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) E] Containers (2821) #of Containers: TA#: TA0516473 4 1,000 Product Type: motor oil (5W-30) Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: TA0517587 5 500 Product Type: motor oil (5W-20) Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 1,815 gallons Total Capacity for Site: gallons Comments: EHD Inspe Reviewed n Date:/ Entered Date: By Initial: '! (7 -713 By Initial: eground stor a tank means a tank that has the capacity to st re 55 gallons or more of pletroleum. '* ontainer means a storage device designed to be moved when full. EHD 28-01 REV 04/19/12 AST SURVEY FORM